Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Drew G. Faust
President of Harvard University 22+ year BC survivor
From anecdote
to evidence
Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries
1: Innovative Delivery 2: Access: Affordable Meds, Vaccines & Techs 3: Innovative Financing: Domestic and Global 4: Evidence for Decision-Making 5: Stewardship and Leadership
16 12 8 4 0
30
1955
1990
20
2010
Nuevo Len
20
Oaxaca
(Poorest)
10
(Wealthiest)
10
1980
2010
1980
2010
Source: Knaul et al., 2008. Reproductive Health Matters, and updated by Knaul, Arreola-Ornelas and Mndez.
Facets
Leukaemia
Russia
All cancers
LOW INCOM HIGH INCOME LOW INCOM HIGH INCOME
In Canada, almost 90% of children with leukemia survive. In the poorest countries only 10% survive.
Facet 5: The most insidious injustice: the pain divide Non-methadone, Morphine
N. America
Equivalent opioid consumption per death from HIV or cancer in pain: Poorest 10%: 54 mg Richest 10%: 97,400 mg US/Canada: 270,000 mg
Asia
India
Africa
Data: http://www.treatthepain.com/methodology Calculations: HGEI/Funsalud Knaul et al. Eds Closing the Cancer Divide.
Latin America
The night of my high school prom visiting my father, Sigmund Knaul, at Mount Sinai Hospital, Toronto a few weeks before his death from cancer. May 1984.
M2. Unaffordable
M3. Inappropriate M4: Impossible
1/3-1/2 of cancer deaths are avoidable: 2.4-3.7 million deaths, of which 80% are in LIMCs
The costs to close the cancer divide are and may be less than many fear:
All but 3 of 29 LMIC priority cancer chemo and hormonal agents are off-patent Pain medication is cheap Prices drop: HepB and HPV vaccines Delivery & financing innovations are underutilized & undeveloped so that purchasing is fragmented and procurement is unstable
PAHO 2013 Strategic Fund for NCDs includes key cancer drugs
M3. Inappropriate
M4: Impossible
Women and mothers in LMICs face many risks through the life cycle
Women 15-59, annual deaths
Mortality in childbirth
-35% in 30 year
Breast cancer
Cervical cancer
Diabetes
342,900
166,577
142,744
120,889
Applies a diagonal approach to avoid the false dilemmas between disease silos -CD/NCD- that continue to plague global health
M4: Impossible
Huge steps in the transition thru reform toward Universal Health Coverage in many countries
Examples: Brazil China Colombia Chile EEUU (Affordable Care Act) El Salvador Peru South Africa Taiwan Mexico: Seguro Popular de Salud
Yetoften in the
context of rapid, profound, polarized and complex epidemiological transition or battling fragmented health systems
2003 REFORM: ELIMINATE SEGMENTATION IN ACCESS TO HEALTH INSURANCE BY GENERATING A SYSTEM FOR SOCIAL PROTECTION IN HEALTH THAT INCLUDES PUBLICALLY FUNDED HEALTH INSURANCE FOR FAMILIES EXCLUDED FROM SOCIAL SECURITY
1943
Social Security
2001/3: Pilot of PHI 2003: Law Jan. 1, 2004: SSPH 2010: Universal coverage of PHI
Frenk et al., 2004.
Seguro
Popular
FUNDS
MOH Budget
Seguro Popular
Affiliation:
2012: 54.6 m
Benefit package:
2004: 113
2012: 284+57
Horizontal Coverage:
Beneficiaries
500 450
57
400
FPCHE EPHS
108 110 49 17 20 49 116
128
128
MING + SP
Number of interventions
350
EPI
CBP
49
57
57
FPCHE 57 interventions
CAUSES 91 FPCHE 6
6 83 6 65 8 65 6 65 12 65 12 65 176 184 189 189
198
198
206
12 65
12 65
13 65
2004
2005
2006
2007
2008
2009
2010
2011
2012
Notes: SP = Seguro Popular MING = Medical Insurance for a New Generation (Children born after December 1, 2006 and until they are 5 years of age) FPCHE = Fung for Protection against Catastrophic Health Expenditure EPHS =Essential Personal Health Services EPI = Expanded Programme of Immunisations CBP= Community-based package
Key aspect of Seguro Popular: diagonal, financial protection for catastrophic illness
Accelerated, universal, vertical coverage by disease with an effective package of interventions 2004/6: HIV/AIDS, cervical cancer, ALL in children 2007: All pediatric cancers; Breast cancer 2011: Testicular and Prostate cancer and NHL 2012: Ovarian (colorectal) cancer
The human faces of Seguro Popular: Guillermina Avila & Abish Romero
Diagnosis
Treatment
Stewardship
Financing
Delivery
Resource Generation
Diagnosis
Treatment
Survivorship
Palliation
Mexico: Large and exemplary investment in financial protection for breast cancer prevention and treatment, yet..a low survival rate. Strengthen early detection, survivorship and palliation: diagonalize delivery
AIDS
Poor Beneficiaries
Rich
RIch
Poor
Juanita:
Advanced metastatic breast cancer is the result of a series of missed opportunities
Diagonalizing Delivery 1: Integration of cervical & breast cancer educatio into anti-poverty programs, Oportunidades
Include information in manuales for community workers 1.5 million promoters > 90% of poor Mexican households: 5.8 million families
Diagonalizing Delivery 2: Training primary care providers in early detection of breast cancer
Promoters (+4000), Nurses & MDs (+1400) medical students (+750)
Nuevo Leon, Jalisco, Morelos, Puebla
Be an optimist optimalist